openIMIS FHIR R4 Implementation Guide - Local Development build (v1.0.0). See the Directory of published versions

Claiming Use Case

In this use case, a Point of Service (PoS) is submitting a claim.

The following code systems are involved in this workflow:

• diagnosis list configured in openIMIS (ICD10 level 1 diagnosis is provided as an example)

The following resources are involved in this workflow:

• ActivityDefinition for the reference to the medical service
• Medication for the reference to the medical item
• Practitioner for the reference to the Claim Administrator submitting the claim
• Organization for the reference to the Health Facility providing the medical services and items

The process is done in two steps:

1. Synchronization of the openIMIS configuration referenced by the necessary resources.
2. Posting the Patients (members of the family), Group (the family) and Contract (enrolment information).

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